New Federal Dietary Guidelines Impact on Chronic Kidney Disease Management With Tim Pflederer, MD

The newly released 2025–2030 federal dietary guidelines for Americans may need careful interpretation for patients with chronic kidney disease (CKD), particularly regarding encouraged protein intake.1

The guidelines, released by the U.S. Department of Health and Human Services (HHS), emphasize protein, recommend limiting processed foods, and encourage a shift toward whole foods. While these recommendations aim to promote general health in the American population, patients with CKD may require tailored guidance based on their kidney function and individual health status.1

Ultimately, nephrologists play a key role in bridging the gap between generalized dietary guidelines and the specific needs of patients with CKD. Dietary management in CKD can also help prevent cardiovascular complications and aid in controlling hypertension and diabetes, common comorbidities. In addition, nutrition may influence how well treatments for kidney disease work. The American Kidney Fund recommends working with a dietitian to develop an individualized, kidney-friendly eating plan accounting for disease stage, comorbidities, and dialysis status.2,3

“A diet that is predominantly plant-based is more protective for the kidneys than a meat-based diet,” said Tim Pflederer, MD, chief medical officer at Evergreen Nephrology in an interview with HCPLive. “Most Americans consume diets heavily centered on meat, so nephrologists work with our patients to encourage moderation in protein intake and a focus on vegetarian or plant-focused protein sources.”

Excess protein intake, particularly from animal sources, increases glomerular filtration workload and generates higher levels of nitrogenous waste, such as urea, which can accumulate in patients with reduced kidney function. High protein diets, especially from meat, can also increase intraglomerular pressure and accelerate kidney damage over time.2,3,4

Plant-based proteins, such as beans, lentils, and nuts, are easier on the kidneys because they generate less acid, produce lower levels of uremic toxins, and contain phosphorus in a less bioavailable form than animal proteins, reducing the risk of hyperphosphatemia. Diets high in acid-producing foods can exacerbate metabolic acidosis, which is common in CKD and contributes to bone demineralization, progression of kidney damage, and increased muscle catabolism.2,3,4,5

“I would divide people with kidney disease into two categories. One is those with CKD who have who whose kidneys are functioning adequately and they're not yet progressed to where they're on dialysis,” said Pflederer. “In that group of patients, it is very clear from the literature that a moderate protein diet is protective of the kidneys compared to a high protein diet, and then actually more importantly is that proteins that are plant based are better for the kidneys.”

Conversely, insufficient protein intake can lead to loss of lean body mass, sarcopenia, and impaired immune function, particularly in patients on dialysis who have higher protein requirements to compensate for amino acid losses during treatment. The optimal protein intake depends on individualized factors including CKD stage, dialysis status, body weight, and comorbid conditions, balancing the need to preserve muscle mass while minimizing renal stress.1

Editor’s Note: Pflederer reports no relevant disclosures.

References

1. Fact Sheet: Trump Administration Resets U.S. Nutrition Policy, Puts Real Food Back at the Center of Health. HHS.gov. Published January 7, 2026. https://www.hhs.gov/press-room/fact-sheet-historic-reset-federal-nutrition-policy.html

2. American Kidney Fund. Kidney-friendly eating plan | American kidney fund. www.kidneyfund.org. Published December 1, 2021. https://www.kidneyfund.org/living-kidney-disease/healthy-eating-activity/kidney-friendly-eating-plan‌

3. National Kidney Foundation. Nutrition and Kidney Disease, Stages 1-5 (Not on Dialysis). National Kidney Foundation. Published 2024. https://www.kidney.org/kidney-topics/nutrition-and-kidney-disease-stages-1-5-not-dialysis

4. ‌Healthy eating for adults with chronic kidney disease. National Institute of Diabetes and Digestive and Kidney Diseases. Published May 10, 2025. https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/healthy-eating-adults-chronic-kidney-disease

5. Ko GJ, Kalantar-Zadeh K. How important is dietary management in chronic kidney disease progression? A role for low protein diets. The Korean Journal of Internal Medicine. 2021;36(4):795-806. doi:https://doi.org/10.3904/kjim.2021.197